外傷により発症した動脈流入過剰型持続勃起症の1例

Abstract

27歳男。患者は疼痛を伴わない不完全勃起の持続を主訴とした。作業中, 直径1cmの鉄筋で会陰部を打撲し, 当日の性交後から主訴が出現した。画像所見等により右陰茎海綿体に流入する動脈が会陰部打撲で破綻し, 海綿体洞との間に瘻孔ができたことで発症した動脈流入過剰型持続勃起症と診断された。更に右内陰部動脈造影検査により右内陰部動脈から分枝する陰茎深動脈の末端に破綻と陰茎海綿体洞への造影剤の溢流が認められた。治療として自己凝血塊を用いた超選択的動脈塞栓術が施行された結果, 塞栓術によって右内陰部動脈分枝からの造影剤の溢流は消失し, また勃起状態の改善も認められ, 3日後に退院となった。目下, 術後2年経過で, 再発ならびに勃起不全は認められていない。

Priapism is rare and usually unpredictable. High-flow priapism is caused by unregulated arterial inflow. Antecedent trauma is the most commonly described etiology. This condition does not require emergent treatment. The initial management of high-flow priapism should be observation, because treatment-related erectile dysfunction may appear. We report a case of high-flow priapism by perineal trauma in a 27-year-old man. His corpora were typically tumescent, but not completely rigid. He could not have sexual intercourse. Blood from the corpus cavernosum was normally oxygenated. Color duplex ultrasonography was performed in the lithotomy position, scanned at the perineum, showed pseudoaneurysmal appearance. Selective internal pudendal arteriography showed a right cavernous arterial extravasation. Superselective embolization of right internal pudendal arteries was performed with an autologous clot. After the procedure, detumescence was achieved as well as erectile function. We recommend superselective arterial embolization as the management of high flow priapism to patients who request treatment.